From stemming blood loss in road-accident victims to ingenious new artificial limbs, many advances in healthcare have their origins on the battlefields of places such as Iraq and Afghanistan.

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Stemming blood loss

The tourniquet, for instance, a mainstay of ancient wars that hadn’t developed much past a piece of rubber tubing with a hook on the end, fell out of use after the Second World War. Dressings were used instead. But these were far from perfect and bleeding from injured limbs remained a leading cause of preventable death.

So medical researchers developed the Combat Application Tourniquet (CAT). Introduced into the kit bags of UK forces in 2005, it has a Velcro strap that allows it to be used one-handed, and it has decreased mortality from extreme blood loss by 85%. It is now standard for most NHS ambulance crews and was used to save victims of the Manchester Arena bombing.

The common bandage has also seen a lot of recent wartime innovation. Barely changed since the First World War, bandages were inefficient at stopping bleeding. ‘They were pretty useless for actually looking after patients,’ says Lieutenant Colonel Ross Moy, a consultant in emergency medicine for the Armed Forces treatment body, Defence Medical Services (DMS). Soldiers found one of their more effective uses was to stop helmets chafing!

That changed in the mid-1980s when trainee Israeli combat medic Bernard Bar-Natan was advised to stem a patient’s bleeding by grabbing a stone to apply some pressure to the bandage. He realised there must be a way for a bandage to do this and, over the next 20 years, developed the ‘Emergency’ or ‘Israeli’ bandage.

This combines a sterile dressing, elastic bandage and pressure applicator capable of exerting up to 30lbs of pressure on the wound. They are now carried by UK ambulances to help road and agricultural accident victims.

A drug that has transferred from civilian use to war zones – and back again – is tranexamic acid (TXA). Commonly prescribed by GPs to reduce heavy periods by forming stronger blood clots, it was repurposed to prevent wounded troops from bleeding to death. Military medics leaving the forces to work with the NHS realised its potential benefit for civilians and it is now widely used by air ambulances.

‘I think TXA would have caught on like this anyway,’ explains Lieutenant Colonel Chris Wright, also a consultant at the DMS. ‘But [its use by the military] moved things on at a much faster pace.’

One of the latest developments in wound care is an injectable foam to stanch internal bleeding long enough for wounded troops to reach surgeons. Developed by the US’s Defense Advanced Research Projects Agency this summer, the self-expanding substance has received approval to be tested in trauma centres around America.

Special ‘shock packs’ were developed to help UK troops in Afghanistan in need of blood transfusions following traumatic amputation. The packs contain red cell concentrate and plasma. Plasma contains a clotting factor that is essential for wound healing.

New temperature-controlled boxes were also developed, so defrosted plasma could last five days rather than just 24 hours, enabling mobile emergency-response teams to fly blood directly to casualties.

‘During our time in Afghanistan, the concept of the shock pack was embraced as it proved to have an effective life-saving outcome,’ explains Captain Dan Willis, of the Royal Centre for Defence Medicine in Birmingham. ‘It meant blood AND plasma were immediately available rather than just blood.’

Many civilian air ambulances have started to carry shock packs.

Pain relief medicines

While morphine was the mainstay pain-reliever for injured troops, the UK military is at the vanguard of ketamine use. Better known as a horse medicine, ketamine is now favoured for its sedating as well as pain-relieving properties, and safer dosing levels. ‘It was introduced around ten years ago,’ says Lieutenant Colonel Ross Moy. ‘It has only come back into civilian practice in the last five or so years.’

New ways of dealing with limb loss

‘It was like something from RoboCop.’ Brendan Gordon on the Saeboglove

Brendan Gordon, 58, a former military medic, served in Kosovo and Northern Ireland before a stroke cost him the use of his right arm and he was discharged in 2012.

‘I’d spent 23 years in the Army,’ he recalls. ‘I went from saving people to not being able to do anything. I attempted suicide, taking an overdose and a bottle of whisky.’

In 2015, he was asked to test the SaeboGlove – a revolutionary plastic glove that extends the tendons and retrains the brain – at the Help for Heroes recovery centre in Colchester.

‘It was like something from RoboCop,’ he recalls. The glove allowed him to open and close his previously clenched hand. He’s now able to carry out far more daily activities and works as a rehabilitation trainer. ‘I feel reborn,’ he says. SaeboGlove is now available privately and there have been several trials for its potential use by the NHS.

The need to address limb loss among veterans has advanced the progression of smart prosthetics, with trials taking place at Headley Court, the Defence Medical Rehabilitation Centre in Surrey.

Former Army captain, Ibrar Ali was injured by a roadside bomb in Basra in 2007: ‘I looked down. My wrist was destroyed,’ he recalls. After life-saving treatment, Ibrar went to Headley Court, where he became one of the first patients to benefit from the i-limb — a sophisticated prosthetic arm that uses muscle signals in the patient’s remaining bit of limb to stimulate movement.

He was back on the front line by 2012 and has since run seven marathons on seven continents for charity. ‘Without the clinicians at Headley Court, I may not have had that drive to get on with my life,’ he says.

In 2013, 16-year-old Patrick Kane, who lost his hand to meningitis as a baby, became the first UK civilian to benefit from a more advanced version of the i-limb, controllable via a smartphone app.

In 2013, 16-year-old Patrick Kane, who lost his hand to meningitis as a baby, became the first UK civilian to benefit from a version of the i-limb.

Last year, NHS England approved funding for the use of microprocessor knees for patients, using similar technology. Some 53 patients have completed a trial and been prescribed the new joints.

Thanks to the Armed Forces’ rehabilitation expertise, some 85% of injured troops now return to military duties, compared with less than 20% of similarly injured civilians who go back to work. Headley Court relocates to Stanford Hall in Nottinghamshire next year. The Government is considering opening a civilian-focused unit there, too – recognition that we can all benefit from these amazing developments.

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